全膝关节置换治疗类风湿性膝关节炎的早期急性并发症

文题释义：全膝关节置换：是通过手术将人工关节假体置入患者膝关节部位，以替代原有的病损关节，达到缓解疼痛、恢复下肢力线及改善患者生活质量的目的，对治疗类风湿性膝关节炎、膝关节退行性病变等膝关节疾病具有显著疗效。 类风湿性关节炎：是一种病因未明的慢性、以炎性滑膜炎为主的系统性疾病。其特征是手、足小关节的多关节、对称性、侵袭性关节炎症，经常伴有关节外器官受累及血清类风湿因子阳性，可以导致关节畸形及功能丧失。晚期累及膝关节的类风湿性关节炎可行全膝关节置换术可显著改善患者生活质量。 背景：类风湿性关节炎患者行全膝关节置换的数量不断增加，但是目前尚无研究报道类风湿性关节炎患者行全膝关节置换后早期并发症的发生情况及相关危险因素。 目的：探讨类风湿性关节炎患者行初次全膝关节置换后早期急性并发症的发生情况及危险因素。 方法：回顾性分析2013年9月至2019年5月于青岛大学附属医院因类风湿性关节炎行初次全膝关节置换的300例患者(337膝)的资料，其中男62例，女238例，平均(65.61±8.40)岁。所有患者对治疗方案均知情同意，且得到医院伦理委员会批准。收集并记录患者基本信息、并存疾病、术前检查、手术信息、住院其他信息及随访资料，分析患者并发症发生的相关危险因素，并利用受试者工作特征曲线计算相关资料对类风湿性关节炎患者术后30 d内并发症的预测价值。 结果与结论：①共9例患者在术后30 d内出现急性并发症，发生率为3.33%；②多因素Logistic回归分析结果显示，并发症组患者手术时间、年龄、病程和术前合并脑血管疾病是类风湿性关节炎患者全膝关节置换后30 d内并发症发生的独立危险因素；③并发症组患者手术时间大于无并发症组(OR=1.023，95%CI：1.001-1.045，P=0.037)，年龄大于无并发症组(OR=1.163，95%CI：1.025-1.319，P=0.019)，病程大于无并发症组(OR=1.110，95%CI：1.031-1.195，P=0.006)，术前合并脑血管疾病比例大于无并发症组(OR=31.736，95%CI：4.053-248.517，P=0.001)；④受试者工作特征曲线表明，年龄、病程及手术时间预测类风湿性关节炎患者全膝关节置换后30 d内并发症的曲线下面积分别为0.693，0.865，0.685。 ORCID: 0000-0003-2279-2742(沈瑞) 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Early acute complications after total knee arthroplasty in patients with rheumatoid arthritis

BACKGROUND:The number of rheumatoid arthritis patients undergoing total knee arthroplasty is increasing,but the postoperative early complications and related risk factors have not been reported.OBJECTIVE:To investigate the early acute complications and the risk factors after primary total knee arthroplasty in patients with rheumatoid arthritis.METHODS:Data of 300 patients(337 knees)with rheumatoid arthritis who received primary total knee arthroplasty at Affiliated Hospital of Qingdao University from September 2013 to May 2019 were retrospectively analyzed.There were 62 males and 238 females,with an age of(65.61±8.40)years old.All patients signed the informed consent,and the study was approved by the ethics committee of the hospital.The baseline data,comorbidities,preoperative examination,surgical data,other data of hospitalization and follow-up data were recorded.The risk factors of complications were analyzed.The receiver operating characteristic curve was used to assess the predictive value of risk factors for postoperative complications within 30 days after surgery in rheumatoid arthritis patients.RESULTS AND CONCLUSION:(1)Nine cases(3.33%)affected acute complications within 30 days after surgery.(2)Multivariate Logistic regression analysis showed that operation time,age,duration of disease and preoperative cerebrovascular disease were independent risk factors for postoperative complications within 30 days after total knee arthroplasty in rheumatoid arthritis patients.(3)Compared with the non-complication group,in the complication group,the operation time was longer(OR=1.023,95%CI:1.001-1.045,P=0.037),the age was increased(OR=1.163,95%CI:1.025-1.319,P=0.019),the duration of disease was longer(OR=1.110,95%CI:1.031-1.195,P=0.006),and the proportion of preoperative cerebrovascular disease was increased(OR=31.736,95%CI:4.053-248.517,P=0.001).(4)The receiver operating characteristic curve to predict the complications in patients with rheumatoid arthritis within 30 days after total knee arthroplasty showed that the area under the curve of age,duration of disease and operation time were 0.693,0.865 and 0.685,respectively.